The Usefulness of Salvage Transplantation in Patients with Hepatocellular Carcinoma

Lee, Kyung Keun; Moon, In Sung; Lee, Myung Duk; Kim, Dong Goo

Abstract

PURPOSE: The treatment of choice for hepatocellular carcinoma (HCC) is either surgical resection or liver transplantation. Liver transplantation has the advantage of treating both the tumor and cirrhosis at the same time. However, due to the shortage of donors the availability of this treatment modality is limited. When recurrence is found after liver resection, liver transplantation (salvage transplantation) is an alternative treatment option, as well as in cases with hepatic failure after resection. We carried out this study to evaluate the usefulness of salvage transplantation in these cases.
METHODS
From October 2000 to September 2007, among 305 patients who underwent living donor liver transplantation at Kangnam St. Mary Hospital, 119 underwent liver transplantation for HCC. Among them, 102 patients received a primary liver transplantation (PT) and 17 salvage liver transplantation (ST). Among those who underwent a ST, 7 had a major liver resection and 10 had a minor resection, prior to the transplantation. During the ST, all patients received right lobe grafts from living donors. Preoperative and postoperative clinical data were analyzed, as well as survival and disease free survival between the PT and ST groups.
RESULTS
There were 5 cases (4.9%) of perioperative mortality in the PT group and 3 cases (17.7%) in the ST group; this difference was without statistical significance. The transfusion requirement for red blood cells was greater in the ST group; but this difference did not reach statistical significance (13.5+/-8.5 units in PT vs. 17.9+/-8.5 units in ST). In addition, there were no significant differences in the recipient operation time (640+/-111 mins in PT vs. 751+/-145 mins in ST), postoperative complication rate (32.3 % in PT vs. 58.8% in ST), reoperation rate (7.8 % in PT vs. 5.9% in ST), and postoperative hospital stay (30.9+/-9.9 days in PT vs. 29.2+/-11.5 days in ST). Furthermore, the 3- and 5-year intention to treat overall survival rate (70.0%, 65.1% in PT vs. 82.4%, 76.0% in ST) were not significantly different.
CONCLUSION
The overall survival and disease free survival rates after ST were similar to those after PT. Salvage transplantation, therefore, may be a useful rescue therapy for patients that develop disease recurrence or deterioration of liver function after liver resection for HCC.